Provider Demographics
NPI:1689087710
Name:RITE AID CORPORATION
Entity Type:Organization
Organization Name:RITE AID CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TENERELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-852-1736
Mailing Address - Street 1:2135 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:ESCALON
Mailing Address - State:CA
Mailing Address - Zip Code:95320-2051
Mailing Address - Country:US
Mailing Address - Phone:209-838-3524
Mailing Address - Fax:209-838-6855
Practice Address - Street 1:2135 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:ESCALON
Practice Address - State:CA
Practice Address - Zip Code:95320-2051
Practice Address - Country:US
Practice Address - Phone:209-838-3524
Practice Address - Fax:209-838-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA668523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy